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Cipro
ciprofloxacin
Black Box Warnings .
Disabling, Potentially Irreversible Serious Reactions
fluoroquinolones associated with tendinitis/tendon rupture, peripheral neuropathy, and CNS effects that may occur together; tendinitis/tendon rupture may occur during tx or months after tx D/C; incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older patients >60 yo, patients taking corticosteroids, and patients with kidney, heart, or lung transplant; D/C immediately and avoid fluoroquinolone use in patients with these serious reactions
Avoid in Myasthenia Gravis
fluoroquinolones may exacerbate muscle weakness in patients with myasthenia gravis
Reserve Fluoroquinolone Use
for patients with no alternative tx options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, or uncomplicated UTI
Adult Dosing .
Dosage forms: TAB: 250 mg, 500 mg; SUSP: 250 mg per 5 mL, 500 mg per 5 mL; INJ: various
infections, bacterial
- [PO route]
- Dose: 250-750 mg PO q12h; Info: dose, duration varies with infection type, severity
- [IV route]
- Dose: 200-400 mg IV q12h; Alt: 400 mg IV q8h for severe/complicated infection; Info: dose, duration varies with infection type, severity
UTI
- [uncomplicated cystitis]
- Dose: 250 mg PO q12h x3 days; Info: for patients with no alternative tx options; refer to IDSA guidelines
- [uncomplicated pyelonephritis]
- Dose: 500 mg PO q12h x7 days; Alt: 400 mg IV x1, then 500 mg PO q12h x7 days total; 400 mg IV q12h x7 days; Info: may give with ceftriaxone or gentamicin; refer to IDSA guidelines
- [complicated]
- Dose: 500 mg PO q12h x7-14 days; Alt: 400 mg IV q12h x7-14 days
intra-abdominal infections, complicated
- [500 mg PO q12h x7-14 days]
- Alt: 400 mg IV q12h x7-14 days; Info: part of multi-drug regimen
bone/joint infections
- [500-750 mg PO q12h x4-8wk]
- Alt: 400 mg IV q8-12h x4-8wk
prostatitis, chronic bacterial
- [500 mg PO q12h x28 days]
pneumonia, hospital-acquired or ventilator-associated
- [400 mg IV q8h x7 days]
- Info: may extend duration based on clinical response; refer to IDSA guidelines
anthrax
- [systemic]
- Dose: 400 mg IV q8h for at least 2wk; Info: 1st-line agent; part of multi-drug regimen; may use as 1st-line agent in pregnant patients; switch to PO antibiotic for post-exposure prophylaxis if inhalational exposure
- [cutaneous]
- Dose: 500 mg PO q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; may use as 1st-line agent in pregnant patients; use extended duration for post-exposure prophylaxis if bioterrorism suspected
- [post-exposure prophylaxis]
- Dose: 500 mg PO q12h x60 days; Info: 1st-line agent; give in combo with anthrax vaccine; may use as 1st-line agent in pregnant patients; may give x42 days or x14 days after last vaccine dose in immunocompetent patients 18-65 yo if anthrax vaccine regimen completed
typhoid fever
- [500 mg PO q12h x2wk]
plague
- [500-750 mg PO q12h x2wk]
- Info: for prophylaxis and tx
chancroid (off-label)
- [500 mg PO q12h x3 days]
salmonellosis, acute (off-label)
- [500-750 mg PO q12h x3-7 days]
- Info: may extend tx x1wk if immunocompromised
salmonella, chronic carrier (off-label)
- [750 mg PO q12h x1mo]
shigellosis, severe (off-label)
- [500-750 mg PO q12h]
- Info: duration varies with infection severity; refer to CDC guidance
febrile neutropenia, chemo-induced (off-label)
- [500-750 mg PO q12h]
- Info: for empiric tx in low-risk patients not on fluoroquinolone prophylaxis; give with amoxicillin/clavulanate
meningococcal prophylaxis (off-label)
- [20 mg/kg/dose PO x1]
- Max: 500 mg; Info: for close contacts of patients with invasive meningococcal disease
infection prophylaxis, surgical (off-label)
- [400 mg IV x1]
- Start: within 120min preop
endocarditis (off-label)
- [400 mg IV q12h]
- Info: not 1st-line tx; dose, frequency, duration vary with pathogen susceptibility, infection severity, valve type; refer to AHA guidelines
renal dosing
- [PO route]
- CrCl 30-50: 250-500 mg PO q12h; CrCl <30: 250-500 mg PO q24h; Info: may give 750 mg/dose if serious infection with severe renal impairment
- HD: 250-500 mg PO q24h, on dialysis days administer after dialysis; no supplement; PD: 250-500 mg PO q24h; no supplement; Info: may give 750 mg/dose if serious infection
- [IV route]
- CrCl <30: 400 mg IV q24h
- HD: 200-400 mg IV q24h, on dialysis days administer after dialysis; no supplement; PD: 200-400 mg IV q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: TAB: 250 mg, 500 mg; SUSP: 250 mg per 5 mL, 500 mg per 5 mL; INJ: various
UTI
- [1-17 yo]
- Dose: 18-30 mg/kg/day IV divided q8h x10-21 days; Max: 400 mg/dose IV; 750 mg/dose PO; Alt: 20-40 mg/kg/day PO divided q12h; Info: for complicated UTI or pyelonephritis; not 1st-line agent
anthrax, systemic
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day IV divided q12h for at least 2wk; Info: 1st-line agent; part of multi-drug regimen; dose depends on gestational and post-natal age; switch to PO antibiotic x60 days total if inhalational exposure
- [1 mo and older]
- Dose: 30 mg/kg/day IV divided q8h for at least 2wk; Max: 400 mg/dose; Info: 1st-line agent; part of multi-drug regimen; switch to PO antibiotic x60 days total if inhalational exposure
anthrax, cutaneous
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day PO divided q12h x7-10 days; Info: for non-systemic infection; 1st-line agent; dose depends on gestational and post-natal age; give antibiotic x60 days total if bioterrorism suspected
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h x7-10 days; Max: 500 mg/dose; Info: for non-systemic infection; 1st-line agent; give antibiotic x60 days total if bioterrorism suspected
anthrax, post-exposure prophylaxis
- [neonates >32 wk gestation]
- Dose: 20-30 mg/kg/day PO divided q12h x60 days; Info: 1st-line agent; dose depends on gestational and post-natal age
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h x60 days; Max: 500 mg/dose; Info: 1st-line agent
plague
- [15 mg/kg/dose PO q8-12h x14 days]
- Max: 500 mg/dose; Info: for prophylaxis and tx
infections, bacterial (off-label)
- [20-30 mg/kg/day PO divided q12h]
- Alt: 15-30 mg/kg/day IV divided q8-12h; Max: 750 mg/dose PO; 400 mg/dose IV
resp. infections, cystic fibrosis patients (off-label)
- [40 mg/kg/day PO divided q12h]
- Alt: 30 mg/kg/day IV divided q8h; Max: 750 mg/dose PO; 400 mg/dose IV
community-acquired pneumonia, moderate-severe bacterial (off-label)
- [>3 mo]
- Dose: 30 mg/kg/day IV divided q12h x10 days; Info: may switch to PO regimen when possible to complete course
salmonellosis, acute (off-label)
- [20-30 mg/kg/day PO divided q12h x3-7 days]
- Max: 750 mg/dose; Info: may extend tx x1wk if immunocompromised
salmonella, chronic carrier (off-label)
- [20-30 mg/kg/day PO divided q12h x1mo]
- Max: 750 mg/dose
shigellosis, severe (off-label)
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q12h; Max: 500 mg/dose; Info: duration varies with infection severity; refer to CDC guidance
typhoid fever (off-label)
- [30 mg/kg/day PO/IV divided q12h x1-2wk]
- Max: 500 mg/dose
chancroid (off-label)
- [preadolescents >45 kg and adolescents]
- Dose: 500 mg PO q12h x3 days
febrile neutropenia, chemo-induced (off-label)
- [20-40 mg/kg/day PO divided q12h]
- Max: 750 mg/dose; Info: for empiric tx in low-risk patients not on fluoroquinolone prophylaxis; give with amoxicillin/clavulanate
meningococcal prophylaxis (off-label)
- [1 mo and older]
- Dose: 20 mg/kg/dose PO x1; Max: 500 mg; Info: for close contacts of patients with invasive meningococcal disease
infection prophylaxis, surgical (off-label)
- [1 yo and older]
- Dose: 10 mg/kg/dose IV x1; Start: within 120min preop; Max: 400 mg/dose
renal dosing
- [adjust dose frequency]
- CrCl 10-29: give usual divided dose q18h; CrCl <10: give usual divided dose q24h
- HD: give usual divided dose q24h, on dialysis days administer after dialysis; no supplement; PD: give usual divided dose q24h; no supplement
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised